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These drugs were prescribed for children covered by Medicaid five times more often than for children with private insurance. Researchers said this disparity should be examined more closely, particularly because these drugs were often prescribed for a so-called off-label use, which is when a drug is used in a different way than has been approved by the U.S. Food and Drug Administration.
"Many [of the children] were diagnosed with behavioral rather than psychotic conditions for which [these drugs] have FDA-approved labeling," study author Julie Zito, a professor in the University of Maryland School of Pharmacy, said in a university news release.
"These are often children with serious socioeconomic and family life problems," she noted. "We need more information on the benefits and risks of using antipsychotics for behavioral conditions, such as attention-deficit/hyperactivity disorder [ADHD], in community-treated populations."
For the study, the researchers examined the use of antipsychotic drugs among 500,000 children ranging in age from 2 to 17.
Children with low family income participating in the state Children's Health Insurance Program or those with very low income in the Temporary Assistance for Needy Families assistance program had the most significant increase in antipsychotic medication use.
Less change occurred in the use of these drugs among the most vulnerable children, such as those in foster care or those with disabilities in the Supplemental Security Income program.
"It raises questions such as 'are the standard treatments for behavior conditions sufficiently evidence-based in community populations.' Outcomes research can answer these questions," Zito said.
Many of the children involved in the study received only one or two prescriptions for antipsychotics before leaving treatment, the researchers added.
"For a behavior problem, it means they just didn't come back, so there may be a continuity problem," Zito said. "This suggests we need more emphasis on uninterrupted community care. But unfortunately, we have a very disjointed health care system."
The study appeared March 1 in the journal Psychiatric Services.
-- Mary Elizabeth Dallas
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